Document Detail

Perioperative mechanical circulatory support in children with critical heart disease.
MedLine Citation:
PMID:  21748290     Owner:  NLM     Status:  PubMed-not-MEDLINE    
The treatment of cardiovascular failure in the perioperative period with the use of mechanical circulatory support is a well-recognized, well-developed, and commonly utilized treatment modality. Regardless of the exact circumstances of initiation, the use of a support device is a "bridge." Where there has been an acute myocardial insult, short-term assist devices can serve as a "bridge to immediate survival," a "bridge to recovery," or even a "bridge to the next decision." Mechanical circulatory support can serve as a treatment of cardiovascular decompensation caused by myocarditis, acute myocardial insult, low cardiac output following surgery, and congenital heart disease. The utilization of such support carries significant risks such as bleeding, infection, and thrombosis. However, these can be minimized in order to allow for the safe and effective deployment of this therapeutic strategy. One specific therapeutic domain in which these devices provide immediate impact is during cardiac arrest. Although outcomes of cardiac arrest remain poor, use of a mechanical device as an intervention has allowed salvage of otherwise certain mortality. However, it is important to note that the utility of support was most pronounced in patients that were not on either extreme of the survival prediction curve. This can be best summarized by the concept of "not too early, not too late." Therefore, it is the responsibility of the entire care team to find the appropriate patient population in which to "pull the trigger" on mechanical support as a therapy. This decision point is supported by a monitoring strategy that can be utilized to predict deterioration and intervene adequately. Most importantly, an effective monitoring strategy allows the practitioner to judge the effectiveness of treatment and support strategies and make adjustments in a timely manner, potentially with mechanical support in the perioperative period.
Paul A Checchia
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Current treatment options in cardiovascular medicine     Volume:  13     ISSN:  1534-3189     ISO Abbreviation:  Curr Treat Options Cardiovasc Med     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-09-05     Completed Date:  2011-11-10     Revised Date:  2013-07-25    
Medline Journal Info:
Nlm Unique ID:  9815942     Medline TA:  Curr Treat Options Cardiovasc Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  414-24     Citation Subset:  -    
Divisions of Critical Care Medicine and Cardiology, St. Louis Children's Hospital, Washington University School of Medicine, One Children's Place, NWT 8th Floor, St. Louis, MO, 63110, USA,
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